The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on computed tomography-guided thermocoagulation of osteoid osteoma.
This procedure can be performed under intravenous sedation or general anesthesia and involves the use of CT guidance.
Step one is to localise the lesion with CT. A trephine bone biopsy needle is then introduced into the lesion. The needle (or sometimes a drill) is then used to create an entry hole through the bone. CT is used to monitor the progress of the needle to ensure placement near the tumour.
The core of the lesion is then removed with the inner trephine needle for biopsy, and a radiofrequency electrode probe is introduced into the centre of the nidus. The probe is then heated to 85-90 degrees centrigrade for 4-6 minutes. The whole procedure takes around 90 minutes. After removal of the electrode, patients are scanned by CT to assess the outcome of the procedure.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.